CAN THE MAIN TRUNK OF GREATER SAPHENOUS-VEIN BE SPARED IN PATIENTS WITH VARICOSE-VEINS

Greater saphenous vein (GSV) is the first-choice venous conduit used f or bypass grafting. However, GSV is more often varicosed than any othe r vein. The purpose of this study was to identify how often the main t runk of GSV could be spared during varicose vein operations. Two hundr ed fifty limbs from 187 consecutive patients with GSV reflux on contin uous-wave Doppler were subsequently examined with color flow duplex im aging. The main trunk of GSV was divided into saphenofemoral junction (SFJ), thigh, knee, and below-the-knee (BK) segments. Reflux and varic osities at all levels were noted. Limbs with previous venous surgery i nvolving GSV were excluded from the study. Reflux throughout the lengt h of GSV was the most common pattern (n=122, 49%). The prevalence of r eflux at the SFJ was 78% (n=196); thigh segment, 84% (n=210); knee, 92 % (n=229); and BK segment, 74% (n=186). Of the segments with reflux, v aricosities were found in 71% at the thigh, 77% at the knee, and 28% ( P<0.0001) at the BK segment. Despite the presence of reflux, the entir e length of GSV was free of varicosities in 46 (18%) limbs. Because th e main trunk of GSV most often lies deeper than its tributaries, in 79 (32%) limbs it was not possible to clinically detect the presence of GSV varicosities. Those varicosities that were clinically evident most often involved the tributaries of GSV (n=232, 93%) that pierce the su perficial fascia and come closer to the skin. One hundred thirty-two i ncompetent perforating veins were found in 71 limbs, of which 27 were connected with the thigh segment, 5 with the knee segment, and the rem aining 100 with the tributaries of the BK segment. No perforating vein was found to be connected with the BK GSV. The main GSV trunk at the BK level frequently had reflux, but it was rarely varicosed. Because t his segment of GSV is not connected to perforating veins, and owing to its intimate anatomic relationship with the saphenous nerve, it may b e spared if not varicosed. In about a fifth of the occasions, the enti re length of GSV was free of varicosities, and at least in high-risk p atients for arterial disease this vein need not be excised.